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The rejected patient who was ‘robbed’ by her doctor

In early days of country practice I was approached by Tricia, who was concerned about her 67-year-old mother Linda, who lived alone in a small settlement. The problem was that Linda was unpopular and isolated because of her sharp tongue and irrational behaviour. Her husband had decamped years ago and her son-in-law refused to visit her. A recent concern was her forgetfulness and tendency to misplace valuable items such as money. She also had an altercation with her neighbours whom she claimed were interfering with her ‘chooks’ and stealing eggs—a claim that was denied. I agreed to call on her on my bimonthly bush rounds to monitor her mental health and medication compliance. My predecessor had noted that her ‘odd’ behaviour was probably caused by fluctuating blood sugar levels because of her insulin-dependent diabetes.

I found Linda to be very pleasant and interesting. She was delighted to have her doctor visit her and I looked forward to getting to know this once talented and productive lady. I conducted a mental state examination and psychiatric assessment which was borderline for dysfunction. She complained that her son-in law was plotting to turn her daughter against her.

Soon rumours started circulation that I was stealing her money during home visits. This distressing allegation led me to reassure Tricia that it was not fact and possibly a delusion. I then diplomatically confronted Linda about the issue and she denied the allegations but said that someone was stealing the money and I was the only regular visitor. About this time I heard a talk on Audio Digest that said that this type of paranoid delusionary behaviour in the postmenopausal period of females was called paraphrenia, which is considered to be an early stage of schizophrenia. So that made sense and following her death from ketoacidosis some eight years later (when she decided to cease her insulin) Tricia found a treasured pile of money in a disused stove.

Paraphrenia or late onset schizophrenia is uncommon but GPs need to be aware of the condition to help management including reassurance of those family members and friends who are affected by the social trauma caused by these people.

It is important to continue to support and maintain a good doctor–patient relationship with patients with paraphrenia. This includes shared care with a specialist in psychotic behaviour which includes confirmation of the diagnosis. This may involve consideration of early dementia which some authorities consider can present with paraphrenia.

Slowing up: it’s just old age … or is it?

I had seen Jack only a few times in the past although I regularly attended other patients in the retirement village where he lived. Jack usually saw another doctor in our surgery. It was not until he developed chronic vascular ulcers on his malleoli ...